The document discusses the anatomy of the shoulder, including bones, joints, ligaments, tendons, muscles, nerves and common injuries. It describes the key bones of the shoulder like the humerus, scapula and clavicle. It also details the main joints of the shoulder such as the glenohumeral joint, acromioclavicular joint, and sternoclavicular joint. The document outlines the important muscles that act on the shoulder and their functions. Common shoulder injuries like rotator cuff tears, tendonitis, frozen shoulder and their treatments are summarized as well. Physical exam maneuvers for evaluating shoulder issues are presented.
7. STERNOCLAVICULAR JOINT
• Saddle joint permitting the
clavicle to move in all 3
planes
• A fused SC would limit all
shoulder motion!
• SCJ disc
• Separates the joint into
two cavities
• Clavicle-disc
Disc-manubrium
8. SCJ, MOVEMENTS
• Functions of the SCJ
• Provide movement of the scapula (along with the
• ACJ)
• Absorb forces from the upper extremity
• Elevatoin
• Depression
• Protraction
• Retraction
• Rotation
9. SCJ MVMT
• Motions allowed at the SCJ
• • Elevation-Depression of the clavicle
• Elevation occurs with shoulder flexion and abduction
• Depression with shoulder extension and adduction
11. • Protraction-Retraction of the clavicle
• Occurs mostly between the disc and the manubrium
• Protraction occurs with shoulder horiz adduction
• Retraction with horiz abduction, shoulder extension
12. • Rotation
• Occurs due to tightening of the coraco- clavicular
ligament during humeral elevation (after 90)
• If no posterior rotation available, can only get 120 of
humeral elevation
14. ACROMIOCLAVICULAR JOINT
• Very difficult joint to characterize; wide variability in the
size and shape of the lateral clavicle
The ACJ is characterized as a plane synovial joint
• ACJ disc
Helps with mobility;
Exists early in life but
thins by age 20-30
15. ACROMIOCLAVICULAR JOINT
• Function of ACJ
• Allows the ability to raise the arm above the head
• Acts like a strut to help with movement of the scapula
resulting in a greater degree of arm rotation
16. ACJ
• Supporting structures of ACJ
• • ACJ capsule
Very weak, relies on ligaments for reinforcement
• • Acromioclavicular ligaments
• • Coracoacromial ligament
• Coraco-clavicular ligament
• Two sections
Conoid (medial)
Trapezoid (lateral)
• Most important stabilizing
structure at the ACJ
Prevents clavicle from over-riding the acromion
Transmits forces from the scapula to the clavicle
19. GLENOHUMERAL JOINT
• Classic ball and socket
• joint
• • Composed of glenoid
• fossa and humeral head
• Fossa only articulates with 25% of the humeral head
• • Sacrifices stability for mobility
20.
21. GH JOINT
• Coraco-acromial Arch
• Prevents upward dislocation of the humeral head
• Protects rotator cuff and humeral head from direct
trauma
22. SCAPULOHUMERAL RHYTHM
• During shoulder ABDuction or flexion
• There is a 2:1 ratio between the GH joint motion and
the scapulothoracic
• joint that take place
For every 2 degrees of GH ABD
The scapula upwardly rotates 1 degree
• Without scapular rotation, the humerus would not be
able to attain full ROM, it would be impinged under the
acromion
27. LATISSIMUS DORSI
• Origin
• T7-T12(T6-T12)
• 9th -12th ribs
• Thoracolumbar fascia
• Iliac crest
• Crest of sacrum
• Insertion
• Bicipital groove of humerus
• Function
• Adduct
• Arm extension
• Internal rotation of arm at the shoulder
35. Teres Major
• Origin
• Inferior border of scapula
• Insertion
• Intertubercular groove of
Anterior humerus
• Function
• Adduct arm
• Internal rotation of arm
• Arm extension(not
hyperextension)
36. Teres Minor
• Is a rotator cuff
muscle
• Origin
• Lateral border of scapula
• Insertion
• Greater tubercle of
humerus
• Function
• Adduct arm
• External rotation of arm
89. Shoulder Movement(10)
Movement Prime mover, other muscles
Flexion Pectoralis major, coracobrachialis
Extension Latissimus dorsi
Abduction Supraspinatus( first30o)+ Deltoid
Adduction Infraspinatus, pectoralis major,
latissimus dorsi
Internal rotation Subscapularis
External rotation Infraspinatous , teres minor
90. Shoulder Movement
Movement Prime mover, other muscles
Elevation Trapezius
Depression Latissimus dorsi, subclavious
Protraction Serratus anterior,
Retraction Rhomboid
92. Rotator Cuff Injuries
• Tendonitis
• OA
• Bursitis
• Impingement syndrome
• 1/3 cases of shoulder pain
• Narrowing space of humerus & Acromion
• Pain on abduction 60-120o
• Anatomical enlargement of joint(AC)& Swelling of tendon and/or
bursae, or weakness of scapulothoracic M. (e.g. Serratus
anterior)
93. Rotator Cuff Injuries
• Rotator cuff tear( tennis shoulder)
• Most common cause of shoulder pain
• Pain during motion & night
• Muscular atrophy & weakness
• Labral tears
• Rim of soft tissue in glenoid
• Connect with biceps tendon
• Injury, age
94. SPEED TEST
• The test is best performed with the patient in a relaxed sitting position
• The arm to be tested should be in about 60 degrees of front flexion
with the forearm supinated and the elbow fully extended
• In the starting position the examiner forcefully presses down on the
patient’s arm at the forearm
• The patient attempts to resist the pressure of the examiner
• Alternatively the patient attempts to
forward flex the shoulder while the examiner
resists
95. Positive Speed Test
• If pain is reported in the bicipital groove
• Weakness in maintaining the forward flexion position will also
likely be noted
• A positive test is indicative of long head of biceps tendon
instability or tendonitis
• Tenderness on palpation of the bicipital groove also indicates
bicipital tendinitis
• When the therapist stops pushing down on the arm a sudden
jerking motion may result
• Pain at this point may indicate a positive test for sub-acromial
bursitis
96. Cross Arm Adduction (Scarf Test)
• Tests AC joint
• A positive test commonly indicates AC joint osteoarthritis
or A-C joint ligament injury such as a ligament sprain or
joint separation
• The A-C joint is very prone to injury due to the small
articulation surfaces that are quite incongruent
• The two surfaces are the
distal end of the clavicle and
the acromion process of the
Scapula
• Injuries usually occur due to
Falls and in contact sports
97. Cross Arm Adduction (Scarf Test)
• The examiner should stand behind the patient on the
side being tested
• Grasp the patient’s arm just distal to the elbow and
passively flex the patient’s shoulder to 90o
• Then maximally adduct the patient’s
shoulder (bring it across their body
towards the other shoulder)
• A positive test is considered if the
patient reports pain during the adduction
motion or localized pain in the AC joint
98. Kim Test
• Purpose
• Detection of a posteroinferior labral lesion
• A - With the patient in a sitting position with the arm 90
degrees of abduction, the examiner holds the elbow and
lateral aspect of the proximal arm, and a strong axial loading
force is applied
• B - while the arm is elevated 45 degrees
diagonally upward, downward and
Backward force is applied to the proximal arm
• A sudden onset of posterior shoulder pain
indicates a positive test result, regardless of accompanying
posterior clunk of the
humeral head
.
99. LAG Test
• Purpose
• To test for rotator cuff tears of the Subscapularis tendon
• Technique
• Patient is seated with examiner behind patient
• The affected arm is brought into maximal internal rotation behind the
back
• Examiner controls patient's arm at the elbow and wrist/hand which is
passively brought into 20 degrees of extension taking the forearm
and hand away from the back
• Instruct patient to actively maintain this position as examiner
releases the wrist but maintains support at the elbow
• A LAG is indicative of a subscapularis tendon tear describe the
magnitude of the LAG in 5 degree intervals with an obvious drop
indicating large or massive tear and a smaller lag revealing a partial
tear
• https://www.youtube.com/watch?v=qi3KK_-R7ZY
100. Tendonitis
• Develop with repetitive overhead activities
• Playing tennis
• Pitching (baseball and golf)
• Painting
• Shoveling
101. Adhesive Capsulitis(frozen shoulder)
• Inflammation and stiffness of GH joint capsule
• Loss of both AROM & PROM
• Constant pain
• Worsen pain at night & cold weather
• Mostly women 40-60 YO
102. Risk Factors Of Frozen Shoulder
• DM
• Stroke
• Lung disease
• RA
• Heart disease
• Immobilization
105. Exercise Protocol
• At least 4 weeks and more for maintenance
• Warm up with walking, stationary bike
• After Codman’s ex., Start with stretching
• Finish with stretching
• Pain free
107. Stretching Exercises, goals
• Make more flexibility
• Prevents contracture
• Restoring range of motion and preventing injury
• Gently stretching after strengthening
exercises can help reduce
muscle soreness and keep
muscles long and flexible
108. Strengthening Ex.
• Help to keep shoulder joint stable
• Can relieve shoulder pain and prevent further injury
109. Walking Wall Stretch
• Using fingers on a
wall
• Hold 10-15 sec
• Reps 10-15
• 3 sets/day
110. Walking Table Stretch
• In sitting position
• Using fingers on a
table
• Hold 10-15 sec
• Reps 10-15
• 3 sets/day